=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770858797
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LABORATORIO CLINICO BORGES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2012
-----------------------------------------------------
Last Update Date | 09/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 168 CALLE ARZUAGA
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00925-3424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-751-6373
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 168 CALLE ARZUAGA
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00925-3424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-751-6373
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MAIRINE BIGIO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-751-6373
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 66076360
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------